Healthcare Provider Details

I. General information

NPI: 1023443215
Provider Name (Legal Business Name): BREANN HAWLEY THOMAS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 GREAT TEAYS BLVD SUITE 6
SCOTT DEPOT WV
25560-9815
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD SUITE 6
SCOTT DEPOT WV
25560-9815
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax: 304-201-5019
Mailing address:
  • Phone: 304-757-6999
  • Fax: 304-201-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberHEN1-0437-9557
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN78846-WHNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: